← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NY
NYDFS-MRF-CPT-01402-NYC
•
New York State Department of Financial Services (NYDFS) & NGS JK MRF Index — New York Metro MSA
•
Nassau County, NY
•
Filing / IDR Window: 2026-11-27
[NYDFS-MRF-CPT-01402-NYC] Empire BlueCross BlueShield & EmblemHealth New York TiC MRF Rate Disparity: Urology & Lithotripsy / Endourology Surgery Center (CPT 52356)
Commercial payer TiC MRF rate disparity audit and ERISA clinical appeal package for New York Urology & Lithotripsy Ambulatory Surgery Centers (CPT 52356 Cystourethroscopy with Ureteroscopy, Laser Lithotripsy & Indwelling Stent, CPT 50590 Extracorporeal Shock Wave Lithotripsy ESWL, CPT 52000 Diagnostic Cystourethroscopy, and CPT 52601 Transurethral Electrosurgical Resection of Prostate TURP) across Blue Cross Blue Shield of New York & UnitedHealthcare.
Cohort MRF 75th-Pct Value
$1,665,000
Target % of Medicare
231.5% MPFS
Statutory Authority
NY-GPCI-2026-NYC (Medicare Locality 13202-01 & NY Ins. Law § 3224-a 12% Prompt-Pay)
ERISA / Timely-Filing Window
120 Days
1. Commercial Payer TiC MRF Allowed-Amount Benchmarks (API #02)
| CPT / DRG Code | Clinical Procedure Description | Unit | Cohort Claims | MRF 25th Pct | MRF Median (QPA) | MRF 75th Pct |
|---|---|---|---|---|---|---|
| CPT-52356 | Cystourethroscopy, with Ureteroscopy and/or Pyeloscopy; with Lithotripsy Including Insertion of Indwelling Ureteral Stent | CLAIM | 240 | $1,400.70 | $3,024.70 | $3,796.10 |
| CPT-50590 | Lithotripsy, Extracorporeal Shock Wave (ESWL) — Renal/Ureteral Calculus (ASC Facility + Professional) | CLAIM | 195 | $1,309.35 | $2,831.85 | $3,532.20 |
| CPT-52000 | Cystourethroscopy (Separate Procedure, Office/ASC Facility Fee & Modifier 25 E/M Unbundling Audit) | CLAIM | 510 | $248.67 | $537.95 | $685.12 |
| CPT-52601 | Transurethral Electrosurgical Resection of Prostate (TURP), Including Control of Postoperative Bleeding, Complete | CLAIM | 110 | $1,674.75 | $3,593.10 | $4,486.30 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
154 Northern Medical Practice (NPI 1710311691)128 Plastic Surgery Associates Pllc (NPI 1720381569)Hospital for Special Surgery (HSS) Manhattan ASCNYU Langone Ambulatory Care CenterNorthwell Health Syosset Surgery CenterMount Sinai Union Square Surgical Center